DESD Work Group Formation-Clinical Quality

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Return to Domain Experts Electronic Voting Summaries

There is a request for a new Work Group that will be a part of Domain Experts. The GOM requires a 2/3 approval, with 60% participation (9) of the DESD WG's. Please review the document below and cast your vote. Enter your name and Name and Work Group. This poll will be open until 11/3 unless quorum is reached.

Clinical Quality Work Group Formation Request

PBS Metrics Not applicable

  • Summary - Passed (6/2/1/2)
    • Number of participants: 9
    • Most popular option: Affirmative
    • Votes in favor: 6
    • Comments: 2
    • Non-participating work groups counted as abstaining solely for the purpose of counting quorum: 0
Co-Chair Affirmative Negative Abstain
Craig Gabron AWG OK
Dianne Reeves (CIC) OK
Mead walker (PSWG) OK
Melva Peters (Pharmacy) OK
Pele Yu (Child Health) OK
Jim McClay (ECWG) OK
Edward Helton-RCRIM OK
John Rhoads (HCD/DEV) OK
Martin Hurrell (Anesthesia) OK
Count 6 2 1


McClay Monday, October 22, 2012 2:32:45 AM GMT-12:00

Formation of this workgroup will lead to fragmentation of domain expertise. 
The Patient Care, EHR, Emergency Care, CDS, etc. already have a focus on improving the quality of care through improved information management. 
The proposed workgroup supposes that quality is somehow different.

Response from Interim co-chairs

There are many workgroups that have a focus on improving the quality of care – in fact, we would suggest that all of HL7 efforts are related to quality. However, the quality community is overwhelmed and split among multiple groups such that many do not participate in HL7. Moreover, there are often single-focused activities in individual workgroups but each does not necessarily develop standards with the end in mind (i.e., with a clear understanding about whatwill be used to evaluate the success of the interoperability efforts. Some examples:

Care coordination using a care plan – an individual care plan has a focus on individual problems (or concerns) and how each is managed individually – the interventions, expected outcomes (goals) and actual outcomes. However, collaboration with the quality domain can enable a fully patient-focused care plan with interventions crossing multiple conditions to improve the complete patient outcomes. This effort will focus on the elements required to evaluate the success of the care plan (i.e., to what extent the goals are met over time).

Clinical decision support work has been focused on delivering rules but without a clear discussion about measuring the value and success of the rules so that effectiveness and efficiency can be evaluated and the rules can coordinate with the measures of quality. A very real example of combined efforts can be merging the existing quality data model (QDM) and the virtual medical record (VMR) to come up with a real usable product. At present, neither is complete and neither is implemented.

The intent of the Quality Committee is to work in concert with existing committees, not in a silo. Such combined work will help focus quality oriented members of HL7, increase participation, and address standards in a more comprehensive manner.

Melva Peters Via email on Wed 10/24/2012

Pharmacy would like to ask the new WG to explain better what they mean with “information technology standards in support of improving health care quality“.  
We believe  that our Rx standard fits that description just the same. Then their relationship to Structured Documents should be made clear. 
The scope description seems to be paradigm-agnostic, but the only ‘explanation of demonstrated need’ is tied to four (unnamed) SD projects.
It appears that this Work Group is an SD spin-off only. We think it’s insufficient to change their name to reflect that though… 
Any (new) group should produce materials that are not tied to any specific implementation style. Since messages and documents are not (yet) compatible
at a payload-level, that may mean they need to produce two sets of artefacts (CMETs for messages and templates for documents). We should no longer tie
up domain expertise to a specific implementation style!

Response from Interim co-chairs

The intent is to help advise existing committees regarding the standards they are creating or updating to focus on the evaluation of the information incorporated in the standards. See the answer to the question above. The workgroup is not an extension of Structured Documents. Rather it is a method to clearly focus on measurement and evaluation as part of every standard related to patient care.

Subsequent to the vote we have received the following additional comments: Dianne Reeves, Tue 10/23/2012

CIC – asks that they also be included in the list of workgroups associated with this new WG

Response from Interim co-chairs


Tom de Jong Wed 10/24/2012

Speaking on behalf of Pharmacy, we would appreciate if our comments would still be addressed, even though the WG formation passed the vote.

Although we definitely support the ambitions of this group (in fact we feel that ourwork would fall under the definition of their scope;-), we are
truly worried about the fact that it’s not clear what kind of artefacts they intend to produce. Ultimately, that’s what HL7 implementers care about.

Response from Interim co-chairs

See comments above. The artifacts should be combined efforts with existing committees, with (perhaps) a Domain Analysis Model, some of which is related to the existing National Quality Forum Quality Data Model (QDM).

Tom de Jong Mon 12/3/2012

Sorry for the delayed response. I am relieved to see that the new work group is not so much focussed on creating separate artefacts, but on supporting other groups in the area of clinical
quality. I do think the project scope statement was unclear about that, so we would still think it’s better to update that accordingly. Also, based on the explanation we have now, Pharmacy WG
would certainly also be in scope for cooperation.

Armando Oliva (RCRIM) Thu 10/25/2012

I have a similar question. Is the focus of the new group the exchange of quality measures with Public Health agencies? Would Clinical Quality
Reporting be more descriptive? I also wonder what artifacts the WG will be working on.

Response from Interim co-chairs

The new committee should work closely with RCRIM and PHER regarding common formats rather than creating new silos of standards.

Jim McClay Thu 10/25/2012

While I entered my comment myself, I represent the emergency medicine informaticscommunity in that all we do aims to improve the quality of care for
our patients. The proposed workgroup did not seek any input from or seek any collaboration with a chunk of the domain experts working in this field.  So I wonder what the proposed focus of the group will be, how they will work with the other domain expert workgroups, and what artifacts the WG will

Response from Interim co-chairs

The new workgroup should make itself available to combined efforts with any other committee. The only limitation will be bandwidth.

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